The Merit-Based Incentive Payment System, or MIPS, has been around for several years. But in reality, what does MIPS participation really mean for your practice? First, are you required to participate in the MIPS program? All physicians enrolled in the Medicare program are required to participate in MIPS if they have been a participating provider for over one year and exceed the low-volume threshold. Participation is important because it has an effect on your Medicare reimbursement. Not participating can result in up to a 9% payment penalty applied to your Medicare reimbursement two years after the reporting year. By participating, you can share in up to a 9% payment bonus. Even if you leave your current practice, the bonus or penalty for that payment year will follow the provider. MIPS reporting has four components – quality, improvement activities, promoting interoperability, and cost measures. Each is weighted to account for a percentage of your final MIPS score. Quality measures are currently set at 30% of the final MIPS score. The provider must collect and submit data on at least six quality measures. Reporting requirements for each measure indicate that the measure must be reported for at least 70% of the patients that meet the measure criteria. To be fully scored, that number must exceed 20 patients. Measure specialty sets are a good way to determine which measures will work best for your practice. Some EHRs collect quality measure information based on the measure criteria. Measure results can also be reported using a registry. Here are a few examples of quality measures that may be reported by interventional cardiologists. These measures include coronary artery disease, antiplatelet therapy, advanced care plan, and controlling high blood pressure. Still have questions about the measures? The measure specifications can be found at qpp.cms.gov. Explore all 25 measures in the cardiology specialty set at qpp.cms.gov slash MIPS slash explore hyphen measures. The second reporting category is improvement activities, which accounts for 15% of the final score. The activities must be performed for a continuous 90-day period in the reporting year. These activities are reported to CMS via attestation. Here are a few examples of improvement activities that may be reported by interventional cardiologists. They include participating in the PCI bleeding campaign, advanced care planning, and the implementation of use of specialist reports back to a referring physician. Visit qpp.cms.gov for a list of descriptions of improvement activities. The third MIPS reporting category is promoting interoperability, which accounts for 25% of the final score. The PI category takes into account the use of electronic information and requires the use of an EHR that meets 2015 certification criteria. The measures fall under a set of five objectives. Here are a few examples of promoting interoperability measures that may be reported by interventional cardiologists. They include clinical data registry reporting, e-prescribing, providing patients electronic access, and both sending and receiving health information electronically for referrals. As always, you can visit qpp.cms.gov to review measure specifications. The final MIPS reporting category is cost measures, which account for 30% of the final score. There is nothing to do for the cost measures. CMS calculates these automatically based on triggering events in each measure. If you do not qualify for any cost measures, this category will be reweighted to another MIPS category. Here are a few examples of cost measures that may be attributable to interventional cardiologists. Elective outpatient percutaneous coronary intervention measure. MIPS value pathways, or MVPs, are a new way to participate in MIPS. MVPs are an all-in-one solution with all of the measures that need to be reported in one place. The MVP is focused on a particular specialty or disease process, so the measures are all focused and apply to specific provider types. MVPs were created to reduce provider burden. There are currently seven MVPs that can be reported, with more in development. Here is an example of an existing MVP for heart disease. The QPP program offers two other programs designed to get providers prepared to take on downside risk. Participation in an alternate payment model without downside risk allows MIPS participation using a preset group of measures with no cost measures. Participating in an advanced APM, which has downside risk, provides exemption from participating in MIPS and a 5% bonus, which is set to expire if Congress does not renew it. Advanced APMs must meet three requirements. They require participants to use certified EHR technology. They provide payments for covered professional services based on quality measures comparable to those used in the MIPS program. And either must be a medical home model expanded under the CMMI authority or requires participants to bear significant financial risk. Not all advanced APMs include specialist participation. The benefits of participating in an advanced APM include a 5% incentive and exclusion from MIPS. These benefits are in exchange for taking on downside risk. Once again, that 5% incentive is set to expire unless Congress takes the steps to renew it. BPCI Advanced is a bundled payment advanced APM that is open to interventional cardiologists. The bundled payment is triggered by an event, such as a procedure or admission, includes payments for a 90-day episode. Five quality measures are required to be tracked. Payment is made as fee-for-service with a retrospective bonus or penalty depending on the attributed costs. Here are some of the clinical episodes that trigger a bundled payment. Here are the types of services included in the payment of a 90-day episode. No matter how your practice currently participates, be an active participant No matter how your practice currently participates, be an active MIPS participant. In traditional MIPS, ask to see your yearly cost report to learn where improvements can be made. And if you're ready, ask about joining an advanced APM.

Merit-Based Incentive Payment System

MIPS

healthcare providers

Medicare reimbursement

MIPS reporting